Abstract
Background
Retroclival hematoma (RCH) is a rare occurrence. The hemorrhage is usually small and hidden and can be easily missed on CT scan. Here, we report the association of a RCH with an odontoid fracture.
Methods
Case report and review of the literature.
Results
We describe a case of a 75-year-old man with a history of squamous cell carcinoma of the tongue base, treated with chemo-radiation. He was on warfarin for atrial fibrillation. He presented to the hospital 6 weeks after falling from standing height, with headache, neck pain, and stiffness. Clinical examination did not show any focal neurologic deficits. INR measured 4 days before admission was 6.0, but therapeutic at 2.4 on the day of admission. CT scan of the head showed a RCH. CT angiogram of the neck unexpectedly showed a type II odontoid fracture with instability of the upper cervical spine and extension of the hematoma to the upper cervical spine. Anticoagulation was reversed with factor IX complex (Bebulin). He underwent C1–C2 fusion without any complications. The immediate post-operative period was unremarkable. Unfortunately, he succumbed to airway obstruction due to mucus plugging 14 days into hospitalization.
Conclusions
In the appropriate clinical setting, when a RCH is found, further imaging should be considered to rule out fracture of the cervical spine. Odontoid fractures can lead to compression of the spinal cord or lower medulla. To prevent neurologic injury and subsequent complications, prompt recognition of type II odontoid fracture should lead to immediate spine stabilization.
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References
McDougall CM, et al. Pediatric traumatic retroclival epidural hematoma. Can J Neurol Sci. 2011;38(2):338–40.
Agrawal D, Cochrane DD. Traumatic retroclival epidural hematoma—a pediatric entity? Childs Nerv Syst. 2006;22(7):670–3.
Paterakis KN, et al. Retroclival epidural hematoma secondary to a longitudinal clivus fracture. Clin Neurol Neurosurg. 2005;108(1):67–72.
Guillaume D, Menezes AH. Retroclival hematoma in the pediatric population. Report of two cases and review of the literature. J Neurosurg. 2006;105(4 Suppl):321–5.
Catala-Antunez I, et al. Abducens nerve palsy due to posttraumatic retroclival and spinal subdural hematoma: case report and literature review. Neurocirugia. 2011;22(4):337–41.
Kwon TH, et al. Traumatic retroclival epidural hematoma in a child: case report. Neurol Med Chir. 2008;48(8):347–50.
Diaz R, Zouros A, Stewart GM. Atlanto-occipital dislocation with retroclival hematoma in a pediatric patient presenting to the emergency department. Pediatr Emerg Care. 2010;26(11):843–7.
de Becco Souza R. Retroclival epidural hematoma in a child affected by whiplash cervical injury: a typical case of a rare condition. Pediatr Neurosurg. 2011;47(4):288–91.
Yang BP. Traumatic retroclival epidural hematoma in a child. Pediatr Neurosurg. 2003;39(6):339–40.
Schievink WI, et al. Spontaneous retroclival hematoma presenting as a thunderclap headache. Case report. J Neurosurg. 2001;95(3):522–4.
Sridhar K, et al. Posttraumatic retroclival acute subdural hematoma: report of two cases and review of literature. Neurol India. 2010;58(21150065):945–8.
Guilloton L, et al. Retroclival hematoma in a patient taking oral anticoagulants. Revue Neurol. 2000;156(4):392–4.
Goodman JM, Kuzma B, Britt P. Retroclival hematoma secondary to pituitary apoplexy. Surg Neurol. 1997;47(1):79–80.
Calli C, et al. Retroclival epidural hematoma secondary to decompressive craniectomy in cerebellar infarction: MR demonstration. J Neuroradiol. 1998;25(3):229–32.
Kwon TH, et al. Traumatic retroclival epidural hematoma in a child: case report. Neurol Med Chir (Tokyo). 2008;48(8):347–50.
Goodman JM, Kuzma B, Britt P. Retroclival hematoma secondary to pituitary apoplexy. Surg Neurol. 1997;47(8986171):79–80.
Guilloton L, et al. Retroclival hematoma in a patient taking oral anticoagulants. Rev Neurol (Paris). 2000;156(4):392–4.
de Bruijn SF, Stam J, Kappelle LJ. Thunderclap headache as first symptom of cerebral venous sinus thrombosis. CVST Study Group. Lancet. 1996;348(8961993):1623–5.
Dodick DW, Wijdicks EF. Pituitary apoplexy presenting as a thunderclap headache. Neurology. 1998;50(9596029):1510–1.
Silbert PL, Mokri B, Schievink WI. Headache and neck pain in spontaneous internal carotid and vertebral artery dissections. Neurology. 1995;45(7644051):1517–22.
Schievink WI, et al. Spontaneous intracranial hypotension mimicking aneurysmal subarachnoid hemorrhage. Neurosurgery. 2001;48(11270540):513–6.
Mizushima H, et al. Epidural hematoma of the clivus. Case report. J Neurosurg. 1998;88(3):590–3.
Suliman HM, et al. Retroclival extradural hematoma is a magnetic resonance imaging diagnosis. J Neurotrauma. 2001;18(11):1289–93.
Watanabe M, et al. Upper cervical spine injuries: age-specific clinical features. J Orthop Sci. 2010;15(4):485–92.
Patel A, et al. Odontoid fractures with neurologic deficit have higher mortality and morbidity. Clin Orthop Relat Res. 2012;470(6):1614–20.
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Datar, S., Daniels, D. & Wijdicks, E.F.M. A Major Pitfall to Avoid: Retroclival Hematoma due to Odontoid Fracture. Neurocrit Care 19, 206–209 (2013). https://doi.org/10.1007/s12028-013-9831-4
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DOI: https://doi.org/10.1007/s12028-013-9831-4